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Ribaudo JG, He K, Madira S, Young ER, Martin C, Lu T, Sacks JM, Li X. Sutureless vascular anastomotic approaches and their potential impacts. Bioact Mater 2024; 38:73-94. [PMID: 38699240 PMCID: PMC11061647 DOI: 10.1016/j.bioactmat.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Sutureless anastomotic devices present several advantages over traditional suture anastomosis, including expanded global access to microvascular surgery, shorter operation and ischemic times, and reduced costs. However, their adaptation for arterial use remains a challenge. This review aims to provide a comprehensive overview of sutureless anastomotic approaches that are either FDA-approved or under investigation. These approaches include extraluminal couplers, intraluminal devices, and methods assisted by lasers or vacuums, with a particular emphasis on tissue adhesives. We analyze these devices for artery compatibility, material composition, potential for intimal damage, risks of thrombosis and restenosis, and complications arising from their deployment and maintenance. Additionally, we discuss the challenges faced in the development and clinical application of sutureless anastomotic techniques. Ideally, a sutureless anastomotic device or technique should eliminate the need for vessel eversion, mitigate thrombosis through either biodegradation or the release of antithrombotic drugs, and be easily deployable for broad use. The transformative potential of sutureless anastomotic approaches in microvascular surgery highlights the necessity for ongoing innovation to expand their applications and maximize their benefits.
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Affiliation(s)
- Joseph G. Ribaudo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
| | - Kevin He
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
| | - Sarah Madira
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
| | - Emma R. Young
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
| | - Cameron Martin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
| | - Tingying Lu
- Department of Plastic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Justin M. Sacks
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
| | - Xiaowei Li
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
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Zhu S, Dou W, Zeng X, Chen X, Gao Y, Liu H, Li S. Recent Advances in the Degradability and Applications of Tissue Adhesives Based on Biodegradable Polymers. Int J Mol Sci 2024; 25:5249. [PMID: 38791286 PMCID: PMC11121545 DOI: 10.3390/ijms25105249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
In clinical practice, tissue adhesives have emerged as an alternative tool for wound treatments due to their advantages in ease of use, rapid application, less pain, and minimal tissue damage. Since most tissue adhesives are designed for internal use or wound treatments, the biodegradation of adhesives is important. To endow tissue adhesives with biodegradability, in the past few decades, various biodegradable polymers, either natural polymers (such as chitosan, hyaluronic acid, gelatin, chondroitin sulfate, starch, sodium alginate, glucans, pectin, functional proteins, and peptides) or synthetic polymers (such as poly(lactic acid), polyurethanes, polycaprolactone, and poly(lactic-co-glycolic acid)), have been utilized to develop novel biodegradable tissue adhesives. Incorporated biodegradable polymers are degraded in vivo with time under specific conditions, leading to the destruction of the structure and the further degradation of tissue adhesives. In this review, we first summarize the strategies of utilizing biodegradable polymers to develop tissue adhesives. Furthermore, we provide a symmetric overview of the biodegradable polymers used for tissue adhesives, with a specific focus on the degradability and applications of these tissue adhesives. Additionally, the challenges and perspectives of biodegradable polymer-based tissue adhesives are discussed. We expect that this review can provide new inspirations for the design of novel biodegradable tissue adhesives for biomedical applications.
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Affiliation(s)
- Shuzhuang Zhu
- College of Chemistry and Chemical Engineering, Yantai University, Yantai 264005, China
| | - Wenguang Dou
- College of Chemistry and Chemical Engineering, Yantai University, Yantai 264005, China
| | - Xiaojun Zeng
- College of Chemistry and Chemical Engineering, Yantai University, Yantai 264005, China
- College of Life Sciences, Yantai University, Yantai 264005, China
| | - Xingchao Chen
- College of Chemistry and Chemical Engineering, Yantai University, Yantai 264005, China
| | - Yonglin Gao
- College of Life Sciences, Yantai University, Yantai 264005, China
| | - Hongliang Liu
- College of Chemistry and Chemical Engineering, Yantai University, Yantai 264005, China
| | - Sidi Li
- College of Chemistry and Chemical Engineering, Yantai University, Yantai 264005, China
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Han GY, Park JY, Back JH, Yi MB, Kim HJ. Highly Resilient Noncovalently Associated Hydrogel Adhesives for Wound Sealing Patch. Adv Healthc Mater 2024; 13:e2303342. [PMID: 38291883 DOI: 10.1002/adhm.202303342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/13/2024] [Indexed: 02/01/2024]
Abstract
The development of hydrogel adhesives with high mechanical resilience and toughness remains a challenging task. Hydrogels must exhibit high mechanical resilience to withstand the inevitable movement of the human body while simultaneously demonstrating strong wet tissue adhesion and appropriate toughness to hold and seal damaged tissues; However, tissue adhesion, toughness, and mechanical resilience are typically negatively correlated. Therefore, this paper proposes a highly resilient double-network (DN) hydrogel wound-sealing patch that exhibits a well-balanced combination of tissue adhesion, toughness, and mechanical resilience. The DN structure is formed by introducing covalently and non-covalently crosslinkable dopamine-modified crosslinkers and physically interactable linear poly(vinyl imidazole) (PVI). The resulting hydrogel adhesive exhibits high toughness and mechanical resilience due to the presence of a DN involving reversible physical intermolecular interactions such as hydrogen bonds, hydrophobic associations, cation-π interactions, π-π interactions, and chain entanglements. Moreover, the hydrogel adhesive achieves strong wet tissue adhesion through the polar hydroxyl groups of dopamine and the amine group of PVI. These mechanical attributes allow the proposed adhesive to effectively seal damaged tissues and promote wound healing by maintaining a moist environment.
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Affiliation(s)
- Gi-Yeon Han
- Program in Environmental Materials Science, Department of Agriculture, Forestry and Bioresources, Seoul National University, Seoul, 08826, Republic of Korea
| | - Ji-Yong Park
- Department of Veterinary Physiology, College of Veterinary Medicine, Seoul National University, Seoul, 08826, Republic of Korea
| | - Jong-Ho Back
- Program in Environmental Materials Science, Department of Agriculture, Forestry and Bioresources, Seoul National University, Seoul, 08826, Republic of Korea
| | - Mo-Beom Yi
- Program in Environmental Materials Science, Department of Agriculture, Forestry and Bioresources, Seoul National University, Seoul, 08826, Republic of Korea
| | - Hyun-Joong Kim
- Program in Environmental Materials Science, Department of Agriculture, Forestry and Bioresources, Seoul National University, Seoul, 08826, Republic of Korea
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Han GY, Kwack HW, Kim YH, Je YH, Kim HJ, Cho CS. Progress of polysaccharide-based tissue adhesives. Carbohydr Polym 2024; 327:121634. [PMID: 38171653 DOI: 10.1016/j.carbpol.2023.121634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
Recently, polymer-based tissue adhesives (TAs) have gained the attention of scientists and industries as alternatives to sutures for sealing and closing wounds or incisions because of their ease of use, low cost, minimal tissue damage, and short application time. However, poor mechanical properties and weak adhesion strength limit the application of TAs, although numerous studies have attempted to develop new TAs with enhanced performance. Therefore, next-generation TAs with improved multifunctional properties are required. In this review, we address the requirements of polymeric TAs, adhesive characteristics, adhesion strength assessment methods, adhesion mechanisms, applications, advantages and disadvantages, and commercial products of polysaccharide (PS)-based TAs, including chitosan (CS), alginate (AL), dextran (DE), and hyaluronic acid (HA). Additionally, future perspectives are discussed.
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Affiliation(s)
- Gi-Yeon Han
- Program in Environmental Materials Science, Department of Agriculture, Forestry and Bioresources, Seoul National University, Seoul 08826, Republic of Korea
| | - Ho-Wook Kwack
- Program in Environmental Materials Science, Department of Agriculture, Forestry and Bioresources, Seoul National University, Seoul 08826, Republic of Korea
| | - Yo-Han Kim
- Department of Agricultural Biotechnology, Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Yeon Ho Je
- Department of Agricultural Biotechnology, Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Hyun-Joong Kim
- Program in Environmental Materials Science, Department of Agriculture, Forestry and Bioresources, Seoul National University, Seoul 08826, Republic of Korea.
| | - Chong-Su Cho
- Department of Agricultural Biotechnology, Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Republic of Korea.
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Monteiro LPG, Rodrigues JMM, Mano JF. In situ generated hemostatic adhesives: From mechanisms of action to recent advances and applications. BIOMATERIALS ADVANCES 2023; 155:213670. [PMID: 37952461 DOI: 10.1016/j.bioadv.2023.213670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
Conventional surgical closure techniques, such as sutures, clips, or skin closure strips, may not always provide optimal wound closure and may require invasive procedures, which can result in potential post-surgical complications. As result, there is a growing demand for innovative solutions to achieve superior wound closure and improve patient outcomes. To overcome the abovementioned issues, in situ generated hemostatic adhesives/sealants have emerged as a promising alternative, offering a targeted, controllable, and minimally invasive procedure for a wide variety of medical applications. The aim of this review is to provide a comprehensive overview of the mechanisms of action and recent advances of in situ generated hemostatic adhesives, particularly protein-based, thermoresponsive, bioinspired, and photocrosslinkable formulations, as well as the design challenges that must be addressed. Overall, this review aims to enhance a comprehensive understanding of the latest advancements of in situ generated hemostatic adhesives and their mechanisms of action, with the objective of promoting further research in this field.
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Affiliation(s)
- Luís P G Monteiro
- Department of Chemistry, CICECO-Aveiro Institute of Materials, University of Aveiro, 3810-193 Aveiro, Portugal
| | - João M M Rodrigues
- Department of Chemistry, CICECO-Aveiro Institute of Materials, University of Aveiro, 3810-193 Aveiro, Portugal.
| | - João F Mano
- Department of Chemistry, CICECO-Aveiro Institute of Materials, University of Aveiro, 3810-193 Aveiro, Portugal.
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Yang G, Li Y, Zhang S, Wang Y, Yang L, Wan Q, Pei X, Chen J, Zhang X, Wang J. Double-Cross-Linked Hydrogel with Long-Lasting Underwater Adhesion: Enhancement of Maxillofacial In Situ and Onlay Bone Retention. ACS APPLIED MATERIALS & INTERFACES 2023; 15:46639-46654. [PMID: 37787379 DOI: 10.1021/acsami.3c09117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Bone retention is a usual clinical problem existing in a lot of maxillofacial surgeries involving bone reconstruction and bone transplantation, which puts forward the requirements for bone adhesives that are stable, durable, biosafe, and biodegradable in wet environment. To relieve the suffering of patients during maxillofacial surgery with one-step operation and satisfying repair, herein, we developed a double-cross-linked A-O hydrogel named by its two components: [(3-Aminopropyl) methacrylamide]-co-{[Tris(hydroxymethyl) methyl] acrylamide} and oxidated methylcellulose. With excellent bone adhesion ability, it can maintain long-lasting stable underwater bone adhesion for over 14 days, holding a maximum adhesion strength of 2.32 MPa. Schiff-base reaction and high-density hydrogen bonds endow the hydrogel with strong cohesion and adhesion performance as well as maneuverable properties such as easy formation and injectability. A-O hydrogel not only presents rarely reported long-lasting underwater adhesion of hard tissue but also owns inherent biocompatibility and biodegradation properties with a porous structure that facilitates the survival of bone graft. Compared to the commercial cyanoacrylate adhesive (3 M Vetbond Tissue Adhesive), the A-O hydrogel is confirmed to be safer, more stable, and more effective in calvarial in situ bone retention model and onlay bone retention model of rat, providing a practical solution for the everyday scenario of clinical bone retention.
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Affiliation(s)
- Guangmei Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yuanyuan Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Shu Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yuting Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Linxin Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Qianbing Wan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xibo Pei
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Junyu Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xin Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jian Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Zhao Z, Li Y, Wang H, Shan Y, Liu X, Wu M, Zhang X, Song X. Ultra-Tough Self-Healing Hydrogel via Hierarchical Energy Associative Dissipation. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2303315. [PMID: 37505367 PMCID: PMC10520617 DOI: 10.1002/advs.202303315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/28/2023] [Indexed: 07/29/2023]
Abstract
Owing to high water content and homogeneous texture, conventional hydrogels hardly reach satisfactory mechanical performance. Tensile-resistant groups and structural heterogeneity are employed to fabricate tough hydrogels. However, those techniques significantly increase the complexity and cost of material synthesis, and have only limited applicability. Here, it is shown that ultra-tough hydrogels can be obtained via a unique hierarchical architecture composed of chemically coupled self-assembly units. The associative energy dissipation among them may be rationally engineered to yield libraries of tough gels with self-healing capability. Tunable tensile strength, fracture strain, and toughness of up to 19.6 MPa, 20 000%, and 135.7 MJ cm⁻3 are achieved, all of which exceed the best known records. The results demonstrate a universal strategy to prepare desired ultra-tough hydrogels in predictable and controllable manners.
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Affiliation(s)
- Zhi Zhao
- Key Laboratory of Advanced Functional MaterialsEducation Ministry of ChinaFaculty of Materials and ManufacturingBeijing University of TechnologyBeijing100124China
| | - Yurong Li
- Key Laboratory of Advanced Functional MaterialsEducation Ministry of ChinaFaculty of Materials and ManufacturingBeijing University of TechnologyBeijing100124China
- Institute of Information Photonics TechnologyFaculty of ScienceBeijing University of TechnologyBeijing100124China
| | - Haibin Wang
- Key Laboratory of Advanced Functional MaterialsEducation Ministry of ChinaFaculty of Materials and ManufacturingBeijing University of TechnologyBeijing100124China
| | - Yupeng Shan
- Key Laboratory of Advanced Functional MaterialsEducation Ministry of ChinaFaculty of Materials and ManufacturingBeijing University of TechnologyBeijing100124China
| | - Xuemei Liu
- Key Laboratory of Advanced Functional MaterialsEducation Ministry of ChinaFaculty of Materials and ManufacturingBeijing University of TechnologyBeijing100124China
| | - Mengfei Wu
- Department of Engineering MechanicsBeijing University of TechnologyBeijing100124China
| | - Xinping Zhang
- Institute of Information Photonics TechnologyFaculty of ScienceBeijing University of TechnologyBeijing100124China
| | - Xiaoyan Song
- Key Laboratory of Advanced Functional MaterialsEducation Ministry of ChinaFaculty of Materials and ManufacturingBeijing University of TechnologyBeijing100124China
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